School Entrance Oral Health Assessments Legislation Becomes Law
10/20/06

School Entrance Oral Health Assessments  

Groundbreaking legislation effective January 1, 2007 requires children entering public school for the first time in either kindergarten or first grade to present proof by May 31 of the school year of having obtained an oral health assessment. That assessment may be completed during the first year of school or any time in the 12 months prior to school enrollment. 

CSPD, working with the California Dental Association, has long sought such regulation as a means of identifying children in need of oral health services and promoting the importance of oral health as an integral component of school readiness and ability to learn.

Dentists should be aware of the following provisions of the bill:  

• Public schools will notify parents and guardians of the requirements imposed by law and provide a standardized form that can be used to record the results of the oral health assessment.
• Parents and guardians may be excused from compliance by indicating the assessment imposes an undue financial burden, cannot be completed because of a lack of access to a dentist or other licensed oral health professional, or because they choose to withhold consent.
• Assessments may be completed by any California-licensed Dentist, Registered Dental Hygienist, or Registered Dental Assistant acting under the direct supervision of the dentist.  

It is important for dentists to understand the difference between a dental examination, which can be performed only by a licensed dentist, and an oral health assessment, which can be performed by a range of licensed dental professionals. An oral health assessment identifies obvious or suspected oral health conditions that require, or might require, examination by a dentist. A dental examination diagnoses dental conditions and forms the basis for treatment recommendations. 

A dental examination conducted in a dental office during the first school year or in the 12 months prior to school enrollment more than meets the minimum standards of the assessment requirement.  

The goal of this legislation is to establish a regular source of dental care (a dental home) for every child. The program will also identify children in need of further examination and dental treatment and will help in the identification of barriers to the delivery of dental care.

Copies of the required state assessment form are expected to be available after January 1, 2007 from the child's school or at www.cde.ca.gov.

For additional information, continue to read "Information on Oral Health Assessments" and download appropriate "In-Office Consent for Assessment and Recommendations Forms" located below.

Questions concerning California Oral Health Assessments may be directed to CSPD Public Policy Advocate, Dr. Paul Reggiardo, at Reggiardo@prodigy.net or by phone at 714-848-0234.

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Information on Oral Health Assessments  

What Does the Law Require?

• Beginning January 1, 2007, schools must notify parents or guardians about this new requirement and provide information on the importance of oral health to overall health and school readiness. It also requires schools to provide enrollment information for government benefit programs such as Medi-Cal and Healthy Families.
• Children entering public school for the first time, in kindergarten or first grade, are instructed to have their oral health assessed by a dental professional by May 31st of the first school year. Oral health evaluations that occurred within the 12 months prior to school entry also meet this requirement.
• Parents may obtain a waiver of this requirement if they cannot find a dental professional to do the evaluation, the assessment poses an undue economic burden, or the parent chooses not to have their child's oral health evaluated.
• Schools must collect and aggregate specified data and school districts must forward specified data by December 31 of each year to their County Office of Education.

What is an Oral Health Assessment?
The assessment, or evaluation, can be met in many ways. It can be a complete examination and treatment plan performed by a dentist, or it can be a more basic oral health evaluation, such as a screening, which can be performed by a dentist, hygienist or a registered dental assistant with supervision.

How should an office respond when a parent calls requesting the required "oral health assessment" for their child? If the child is already a patient of record, it should be a routine matter to schedule a dental examination for the child. The oral health assessment requirement is not intended to alter your usual office protocol with regard to new or recall examinations. The only "new" part of the visit is completion of the required "assessment form." The form is simply a data collection tool and requires information on the following four items:

• The date of the evaluation
• The presence (yes or no) of caries experience as evidenced by visible dental caries or dental restorations
• The presence (yes or no) of visible untreated dental caries
• Assignment to a category of treatment urgency as follows:
  • Urgent (if the child experiences pain or there is evidence of dental infection)
  • Early Dental Care (if caries appears visible without accompanying signs or symptoms or it appears the child would benefit from immediate sealant placement)
  • No Obvious Problems (if the child's teeth appear to be visually healthy and there is no apparent reason for the child to be seen before the next routine check-up)

If the child is a patient-of-record and has had an examination within the last 12 months, the results of that previous examination will satisfy the requirement of the new law.

How should an office respond when the parent of a new patient calls making the same request?
As with all new patients, the child ideally should receive a comprehensive examination. In some instances, however, it may be a multi-step process before a child receives the desired exam. It is therefore important to develop a protocol when the parent questions the need to make an appointment for an examination, citing the request for "just an assessment."

Many factors may contribute to the parent's decision to schedule the recommended examination, including available insurance coverage, the parents' understanding of the difference between an assessment and an examination, and the parents' expectation that an assessment, or basic screening, is all the child needs. An office protocol should include a clear explanation of the differences between a basic screening and a comprehensive examination, so that the parent can make an informed decision.

If, after explaining the value of a comprehensive dental examination, the caller still requests only a screening assessment to meet the basic requirements of law, how might the office proceed? When a dental examination is not feasible, the child will still benefit from the simple assessment intended to identify obvious unmet oral health needs and to provide a data collection tool for state-wide oral health planning. Therefore, CSPD encourages members to consider offering to screen the child and complete the mandated assessment form in the office without charge.

• If choosing to do a screening, rather than a comprehensive exam in the office, be very clear when the appointment is established that you will be conducting the screening, at no charge, as a public service. When the adult and child arrive, an In-Office Consent and Recommendation Form, very similar to the consent form used at school-based screenings, should be signed. This form will make it explicit that the child receiving the screening is not a patient-of-record and will establish the parameters of the free service you are providing. CSPD and CDA have jointly developed an In-Office Consent and Recommendation Form for use in the dental office which is available on the CSPD and CDA websites. This form should be filled-out and given to the parent, along with the state-mandated data collection form (which is returned to the school). The dentist is advised to keep a copy of these forms together in a separate file for a period of one year, after which they may be discarded.
• Providing an assessment in the dental office provides an opportunity for the parent to become educated about the condition of their child's oral health, the consequences if disease is not treated, and the benefits of ongoing care. The "screening" can become an invitation to establish a dental home for the child.

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CSPD/CDA Developed  
In-Office Consent for Assessment and Recommendations Forms 

Download appropriate forms:

• English
• Chinese
• Hmong
• Russian
• Spanish
• Vietnamese

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